BEFORE THE HON’BLE LABOUR-CUM-CONCILIATION OFFICER OF

BEFORE THE HON’BLE LABOUR-CUM-CONCILIATION OFFICER OF ……………………………….

Reference No: _____________ of 20……………

………………………………………………………………………………………….………………Workmen

Versus

………………………………………………….……………………………………………………….Employer/Respondent

In the matter of -ABOVE MENTIONED- I/we hereby authorize Shri __________________ to represent me in the above matter.

Dated this ______.

Signatures of person nominating the representative

Address :

Accepted

Signatures of Representatives

Address:

________________________